Aging and dementia, part 2

By Alan Koenigsberg, M.D.

Last week, I reviewed fear and dealing with it, specifically relating to getting older and the fear of developing dementia. This week, as a follow-up, I would like to point out and discuss that many if not most cases of having some memory troubles as we get older may be caused by many other conditions and not dementia.

First, as we age, our memory becomes a bit less agile. In our 60s and further on, we may have an occasional experience of struggling to find the word we are seeking. That’s not dementia or early dementia; that’s a normal part of the aging process. Getting lost repeatedly when driving home, leaving the boiling pot of water on the stove top repeatedly, that may be.

One of the many topics we covered in my psychiatry residency was a rotation of gero-psychiatry, which was the term for psychiatric evaluation and care of those over 65 or so. Much of the work was done in an inpatient setting, but a considerable amount of time was also spent in a clinic setting. We saw quite a large number of older men and women brought in by family members who were concerned about parents, aunts and grandparents who were exhibiting memory problems.

We would do a thorough history of the patient’s condition, with information from family members as well as the patient themselves. Depending on what we obtained, we would request basic lab tests.

What I found frequently was not dementia, but one of several other, treatable conditions. Here they are, in no particular order, but the first was one I ran into rather frequently.

Many of the elderly patients did indeed have moderate to serious memory problems. They couldn’t remember what they ate, how to drive home, the date, doctor’s appointments and so on. However, they clearly knew their family members, knew what objects were and what they were used for. The distinguishing feature was that they complained about their memory problems, which is often an outstanding feature of memory loss due to dementia. The problem was that they were experiencing a depressive illness, which, in the elderly, looks quite similar to dementia. It is fairly easily distinguished, and the patients that I worked with readily improved when I prescribed them antidepressant medications.

Then there are patients who lose their eyeglasses or hearing aids and suddenly appear demented. However, when their ability to see or hear is taken, external stimuli are gone and they get easily confused. Again, I vividly remember evaluations such as that of an elderly woman in the emergency department; after clearing her ears of wax from years of buildup and asking her grown daughter to go home and retrieve her eyeglasses, we sent her home later that day.

Another relatively common condition in older women is a urinary tract infection. It seems as though elderly women with cystitis frequently experience substantial changes in mental status when they develop a urinary infection.

Then there are vitamin deficiencies, low thyroid, strokes, anemia, liver and kidney diseases, cardiovascular conditions that limit oxygen to the brain, hormones, infections, cancers, malnourishment and so on.

There is a general syndrome called MCI, minimal cognitive impairment, in which the person may show some clear signs of memory impairment and may rely on memory aids but does indeed function independently. This condition may progress to dementia but often does not.

My intended take-home is to live healthy, live well, strive to stay active physically, emotionally, intellectually and socially. Avoid excess alcohol and nicotine, watch your weight and strive to learn new things as you continue to age.

If you or a loved one begins to notice memory problems, get a thorough baseline checkup and follow-up. You may very well pick up eminently treatable conditions that can easily improve, but worsen if ignored.

If you don’t have a family physician or internist, get one and see them annually. Take care of the body you inhabit!

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas. He can be reached at akoenigsberg@mac.com.

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